Rehabilitative Services Policy

Sexual Abuse Evaluation And Treatment Program

Introduction

Sexual abuse specific evaluation and treatment are specialized services provided to children and families where sexual abuse has taken place or is suspected. 

Sexual Abuse Evaluation and Treatment services are provided to the following groups of children who are Medicaid eligible:

  • Victims of sexual abuse
  • Abuse reactive children 
  • Children/Youth with problematic sexual behavior

Sexual abuse services are provided in two phases: evaluation and treatment.

Evaluation

The evaluation phase consists of the following:

  • A review of pertinent documentation related to the presenting situation
  • The development of a clinical strategy to see the child, family and significant individuals
  • Interviewing the child, family and significant individuals
  • Consult with collateral contacts (e.g., DCYF, police and other providers) 
  • A review of protective issues and recommendations 
  • Administer pertinent assessment tools
  • Formulation and written report 
  • Review and provide a copy of completed evaluation to non-offending caretakers/parents and service providers, as deemed suitable. 

    With some clients there may be a need to refer for psychological testing.

    Treatment

    The treatment phase consists of the following:

    • Direct therapeutic intervention which takes the form of group, individual and/or family therapy.
    • Coordination of the (potential) multi-agency involvement (police, DCYF, courts, placement/service providers) with the child/youth and their family, with the goals of protection and maximization of the effectiveness of services.

    Provider Participation Requirements

    The provider adheres to the National Culturally and Linguistically Appropriate Services (CLAS) Standards in Health and Health Care. ( https://www.thinkculturalhealth.hhs.gov/clas

    Two levels of qualifications are recognized for providers:

                       1.     Qualified

                       2.     Intern

    Providers at the Qualified level supervise providers at the Intern level.

    The provider at either level of qualification meets the following criteria:

    1.    Does not have a conviction or a deferred judgment for any offense listed on the Department’s Disqualifying Information Addendum.  (Refer to DCYF Policy 900.0040: Criminal Records Checks).

    2.    Complies with generally accepted standards of practice of their mental health profession and the Professional Code of Ethics.

    A provider approved at the Qualified level also meets the following criteria (in addition to criteria outlined above).

    1.    Is a Doctoral or masters level clinician independently licensed in the State of Rhode Island in the field of medicine, psychology, nursing, social work, mental health counseling or marriage and family counseling.

    2.     Is a certified Medicaid provider in Rhode Island.

    3.     Has completed, within the last five years, a minimum of one thousand supervised hours of clinical experience.

    a.    Providers treating youth with problematic sexual behavior have clinical experience in the areas of assessment and treatment of youth who commit sexual offenses, exhibit sexually abusive behavior or are affected by sexual abuse.  At least half of these required hours are direct clinical contact.

    b.    Providers treating youth affected by sexual abuse have clinical experience in the areas of assessment and treatment of youth affected by sexual abuse.  At least half of these required hours are direct clinical contact.

    c.     The provider may request credit for training outside of topic areas by submitting documentation to the Department’s Community Services and Behavioral Health division demonstrating relevance.

    d.    The provider completes required continuing education credits.

    4.     Providers treating youth affected by sexual abuse complete within the last five years at least sixty hours of documented training to include:

    a.    Thirty hours of victim related topic areas.

    b.    Eighteen hours of general topic areas.

    c.     Twelve hours of sexual abuse specific training.

    5.     Providers treating youth with problematic sexual behavior complete within the last five years at least sixty hours of documented training to include:

    a) Thirty hours of sexual abuse specific training.

    b) Eighteen hours of general topic areas.

    c) Twelve hours of victim related topic areas.

    A provider approved at the Intern level also meets the following criteria (in addition to criteria outlined above):

    1.           Is enrolled in a master’s or doctorate degree program from an accredited university in a behavioral science;

    2.           Treats the youth under the direct supervision of a provider at the Qualified level who is responsible for signing off on all documented work; 

    3.           Participates in co-therapy with a provider at the Qualified level (including evaluation);

    4.           Receives clinical supervision as determined by the provider at the Qualified level.  Clinical supervision includes co-therapy and direct observation of the intern conducting the treatment.


    Specialized Training

    Specialized training in the foundation of child sexual abuse issues (e.g., victim/offender) to include dynamics, interviewing, assessing, evaluation, treatment modalities and legal issues is required of all providers of sexual abuse services.


    Continuing Education/Training

    A minimum of 30 hours biannually (4 days/6 hours each) of specialized sexual abuse training, validated by official documentation for seminars. 

    *To include 15 hours of victim related topic areas, 6 hours sexual abuse specific, and 9 hours general topic areas.


    S upervision/Consultation

    Supervisors or consultants must have met the criteria specified above for base and continuing requirements, as well as a minimum of two years of supervised experience working with abuse victims and/or offenders.

    Covered Services

    Evaluation services consist of the following components and time allotments:

    • Review of clinical documentation (1 hour)
    • Collateral contacts  (2 hours)
    • Direct contact with client  (4 hours) 
    • Direct contact with caretakers (2 hours)
    • Writing  (4 hours)
    • Consultation  (1 hour)

    An Individual and Family Treatment Unit consists of ongoing direct therapy and/or care coordination activities provided by one clinician.

    A Group Treatment Unit consists of two clinicians providing direct therapy and/or care coordination services.

    Note: For psychological evaluation codes and reimbursement amounts, refer to the Medicaid fee schedule.

    The following table lists all covered services for Sexual Abuse Evaluation and Treatment. The table shows the procedure code, service description and if the service requires prior authorization (Y-yes or N-no).

    Sexual Abuse Evaluation and Treatment

    Procedure Code and Modifier Description PA
    H0031 HO or HP Sexual Abuse Evaluation Y
    H0004 HR and HO or HP Sexual Abuse Individual Counseling and Therapy, per 15 minutes Y
    H0004 HQ and HO or HP Sexual Abuse Group Counseling and Therapy, per 15 minutes Y